Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OCUTRICIN HC OPHTH/3.5GM

Facility

$13.00

Hospital Charge Code	60633568
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

OCUTRICIN HC OPHTH/7.5ML

Facility

$28.00

Hospital Charge Code	60633567
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

OCUTRICIN HC OPHTH/7.5ML

Facility

$28.00

Hospital Charge Code	60633567
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

OCUVITE MULTIVIT W MINERLS TAB

Facility

$1.25

Hospital Charge Code	60629870
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Qualcare PPO/HMO/WC	$0.19

OCUVITE MULTIVIT W MINERLS TAB

Facility

$1.25

Hospital Charge Code	60629870
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.63
Rate for Payer: Aetna Commercial	$0.48
Rate for Payer: Aetna Medicare Advantage	$0.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.32
Rate for Payer: Cigna Commercial	$0.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.38
Rate for Payer: Oxford Commercial	$0.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.19
Rate for Payer: UnitedHealthcare Commercial	$0.25
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

OF,ANKLE FRACTURE

Facility

$48,992.10

Service Code	HCPCS 27766
Hospital Charge Code	16000399
Hospital Revenue Code	360
Min. Negotiated Rate	$1,180.71
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,697.63
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,180.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,298.29

OF,ANKLE FRACTURE

Facility

$48,992.10

Service Code	HCPCS 27766
Hospital Charge Code	16000399
Hospital Revenue Code	360
Min. Negotiated Rate	$7,348.81
Max. Negotiated Rate	$7,348.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81

OF CLAVICLE FRACTURE

Facility

$63,943.60

Service Code	HCPCS 23515
Hospital Charge Code	16000390
Hospital Revenue Code	360
Min. Negotiated Rate	$9,591.54
Max. Negotiated Rate	$9,591.54
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54

OF CLAVICLE FRACTURE

Facility

$63,943.60

Service Code	HCPCS 23515
Hospital Charge Code	16000390
Hospital Revenue Code	360
Min. Negotiated Rate	$1,355.00
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,183.08
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,541.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,694.51

OFFICE CONSULT COMPREHENSIVE

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	74308335
Hospital Revenue Code	514
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$580.30
Rate for Payer: Aetna Commercial	$441.03
Rate for Payer: Aetna Medicare Advantage	$348.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.95
Rate for Payer: Cigna Commercial	$580.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.18
Rate for Payer: Qualcare PPO/HMO/WC	$174.09
Rate for Payer: UnitedHealthcare Community & State	$27.97
Rate for Payer: Wellpoint Medicaid Managed Care	$30.76

OFFICE CONSULT COMPREHENSIVE

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	74308335
Hospital Revenue Code	514
Min. Negotiated Rate	$174.09
Max. Negotiated Rate	$174.09
Rate for Payer: Qualcare PPO/HMO/WC	$174.09

OFFICE CONSULT COMPREHENSIVE

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	83653210
Hospital Revenue Code	514
Min. Negotiated Rate	$174.09
Max. Negotiated Rate	$174.09
Rate for Payer: Qualcare PPO/HMO/WC	$174.09

OFFICE CONSULT COMPREHENSIVE

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	83653210
Hospital Revenue Code	514
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$580.30
Rate for Payer: Aetna Commercial	$441.03
Rate for Payer: Aetna Medicare Advantage	$348.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.95
Rate for Payer: Cigna Commercial	$580.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.18
Rate for Payer: Qualcare PPO/HMO/WC	$174.09
Rate for Payer: UnitedHealthcare Community & State	$27.97
Rate for Payer: Wellpoint Medicaid Managed Care	$30.76

OFFICE CONSULT DETAILED

Facility

$245.50

Service Code	HCPCS 99243
Hospital Charge Code	412399243
Hospital Revenue Code	510
Min. Negotiated Rate	$36.83
Max. Negotiated Rate	$36.83
Rate for Payer: Qualcare PPO/HMO/WC	$36.83

OFFICE CONSULT DETAILED

Facility

$245.50

Service Code	HCPCS 99243
Hospital Charge Code	412399243
Hospital Revenue Code	510
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$122.75
Rate for Payer: Aetna Commercial	$93.29
Rate for Payer: Aetna Medicare Advantage	$73.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.60
Rate for Payer: Cigna Commercial	$122.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.65
Rate for Payer: Qualcare PPO/HMO/WC	$36.83
Rate for Payer: UnitedHealthcare Community & State	$5.92
Rate for Payer: Wellpoint Medicaid Managed Care	$6.51

OFFICE CONSULT EXPANDED

Facility

$225.20

Service Code	HCPCS 99242
Hospital Charge Code	412399242
Hospital Revenue Code	510
Min. Negotiated Rate	$33.78
Max. Negotiated Rate	$33.78
Rate for Payer: Qualcare PPO/HMO/WC	$33.78

OFFICE CONSULT EXPANDED

Facility

$566.00

Service Code	HCPCS 99242
Hospital Charge Code	83653205
Hospital Revenue Code	514
Min. Negotiated Rate	$13.64
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$215.08
Rate for Payer: Aetna Medicare Advantage	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.33
Rate for Payer: Cigna Commercial	$283.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.80
Rate for Payer: Qualcare PPO/HMO/WC	$84.90
Rate for Payer: UnitedHealthcare Community & State	$13.64
Rate for Payer: Wellpoint Medicaid Managed Care	$15.00

OFFICE CONSULT EXPANDED

Facility

$225.20

Service Code	HCPCS 99242
Hospital Charge Code	412399242
Hospital Revenue Code	510
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$112.60
Rate for Payer: Aetna Commercial	$85.58
Rate for Payer: Aetna Medicare Advantage	$67.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.43
Rate for Payer: Cigna Commercial	$112.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.56
Rate for Payer: Qualcare PPO/HMO/WC	$33.78
Rate for Payer: UnitedHealthcare Community & State	$5.43
Rate for Payer: Wellpoint Medicaid Managed Care	$5.97

OFFICE CONSULT EXPANDED

Facility

$566.00

Service Code	HCPCS 99242
Hospital Charge Code	83653205
Hospital Revenue Code	514
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$84.90
Rate for Payer: Qualcare PPO/HMO/WC	$84.90

OFFICE CONSULT FOCUSED

Facility

$453.00

Service Code	HCPCS 99241
Hospital Charge Code	83653200
Hospital Revenue Code	761
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$226.50
Rate for Payer: Aetna Commercial	$172.14
Rate for Payer: Aetna Medicare Advantage	$135.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.52
Rate for Payer: Cigna Commercial	$226.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.90
Rate for Payer: Oxford Commercial	$90.60
Rate for Payer: Qualcare PPO/HMO/WC	$67.95
Rate for Payer: UnitedHealthcare Commercial	$90.60
Rate for Payer: UnitedHealthcare Community & State	$10.92
Rate for Payer: Wellpoint Medicaid Managed Care	$12.00

OFFICE CONSULT FOCUSED

Facility

$453.00

Service Code	HCPCS 99241
Hospital Charge Code	83653200
Hospital Revenue Code	761
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$67.95
Rate for Payer: Qualcare PPO/HMO/WC	$67.95

OFFICE CONSULT MINOR

Facility

$174.55

Service Code	HCPCS 99241
Hospital Charge Code	412399241
Hospital Revenue Code	510
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$87.28
Rate for Payer: Aetna Commercial	$66.33
Rate for Payer: Aetna Medicare Advantage	$52.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.51
Rate for Payer: Cigna Commercial	$87.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.37
Rate for Payer: Qualcare PPO/HMO/WC	$26.18
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

OFFICE CONSULT MINOR

Facility

$174.55

Service Code	HCPCS 99241
Hospital Charge Code	412399241
Hospital Revenue Code	510
Min. Negotiated Rate	$26.18
Max. Negotiated Rate	$26.18
Rate for Payer: Qualcare PPO/HMO/WC	$26.18

OFFICE OP VISIT EST - I

Facility

$368.18

Service Code	HCPCS 99211
Hospital Charge Code	85000845
Hospital Revenue Code	510
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$184.09
Rate for Payer: Aetna Commercial	$139.91
Rate for Payer: Aetna Medicare Advantage	$110.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.89
Rate for Payer: Cigna Commercial	$184.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.45
Rate for Payer: Qualcare PPO/HMO/WC	$55.23
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.76

OFFICE OP VISIT EST - I

Facility

$368.18

Service Code	HCPCS 99211
Hospital Charge Code	85000845
Hospital Revenue Code	510
Min. Negotiated Rate	$55.23
Max. Negotiated Rate	$55.23
Rate for Payer: Qualcare PPO/HMO/WC	$55.23

Know your out-of-pocket cost for care.

All Charges